Chronic Pulmonary Thromboembolism (Disorder), Heart Failure With Preserved Ejection Fraction
Conditions
Keywords
Exercise hemodynamic test, Heart failure with preserved ejection fraction, Cardiac catheterization
Brief summary
To evaluate the role of exercise hemodynamic testing in the diagnostic workup for patients with dyspnea on exertion referred to the catheterization lab.
Detailed description
Heart failure with preserved ejection fraction (HFpEF) is a major public health problem that has no proven effective treatment. However, in practice, it's difficult to recognize early stage of HFpEF by resting hemodynamic study and echocardiography because the patients mainly complaint of dyspnea only during exercise but not resting condition. Accordingly, exercise stress test will be helpful to provide more information on pathophysiology, diagnosis, and severity in various cardiovascular diseases such as HFpEF, valvular heart disease, and chronic thromboembolic pulmonary hypertension. Thus, the broad objective of this proposal is to characterize the dynamic changes in cardiopulmonary mechanics during stress in patients with exertional dyspnea, establishing a comprehensive multimodality diagnostic approach to the evaluation of exercise intolerance. Specifically, this study will compare established and novel parameters derived from echocardiography and CPX with simultaneous, gold standard invasive measures of cardiovascular hemodynamics at rest and with exercise stress to define the role of noninvasive testing in the diagnostic workup for patients with dyspnea on exertion referred to the catheterization lab.
Interventions
DIAGNOSTIC_TESTExercise hemodynamic test
Assessment of pulmonary hemodynamics during exercise by right heart catheterization and cardiac function during exercise by a simultaneous transthoracic echocardiography
Sponsors
Samsung Medical Center
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
19 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Subject must be at least 19 years of age. * Patients with dyspnea on exertion * Written informed consent of participating subjects after being fully briefed (for prospective analysis)
Exclusion criteria
* Patients with incomplete hemodynamic data at rest or exercise * Advanced tumor disease or other diseases with a short life expectancy * Uncontrolled systemic arterial hypertension ( \> 160/100 mmHg at rest) * FEV1\<50% predicted * TLC\<60% predicted
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of exercise induced pulmonary artery wedge pressure >25 mmHg | during the procedure | Number of Participants with Diagnosis of earlier heart failure with preserved ejection fraction based on exercise PCWP |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The change of right ventricular systolic pressure (RVSP) between at rest and peak exercise | between at rest and peak exercise | The change of RVSP between at rest and peak exercise |
| Proportion of exercise induced pulmonary hypertension > 30 mmHg | during the procedure | Number of Participants with Diagnosis of pulmonary hypertension based on mean pulmonary pressure at peak exercise |
| Correlation between peripheral venous pressure and right atrial pressure assumed by echocardiography | during the procedure | Correlation between peripheral venous pressure and right atrial pressure assumed by echocardiography |
| Ventilatory mechanics | during the procedure | ratio of minute ventilation to carbon dioxide production (VE/VCO2) |
| Aerobic capacity | during the procedure | peak oxygen consumption (VO2) |
| coronary flow reserve | during the procedure | invasively measured coronary flow reserve |
| index of microcirculatory resistance | during the procedure | invasively measured index of microcirculatory resistance |
| Lactate level at peak exercise | during the procedure | Serum lactate level at peak exercise |
| LA stiffness | during the procedure | LA stiffness measured by LA strain/E/e' using Transthoracic echocardiography |
| change of E/e' between at rest and peak exercise | between at rest and peak exercise | The change of E/e' between at rest and peak exercise |
| Rates of rehospitalization due to heart failure | 5 years follow-up | Rehospitalization due to heart failure |
| Rates of all-cause death | 5 years follow-up | Follow-up death |
| change of Tricuspid annular plane systolic excursion (TAPSE) between at rest and peak exercise | between at rest and peak exercise | The change of TAPSE between at rest and peak exercise |
| change of S' between at rest and peak exercise | between at rest and peak exercise | The change of S' between at rest and peak exercise |
Countries
South Korea
Contacts
Primary ContactJeong Hoon Yang, MD
Backup ContactKi Hong Choi, MD
Outcome results
None listed